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1.
Angiol Sosud Khir ; 27(1): 191-198, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33825748

RESUMO

According to the results of modern researchers, the main techniques used in congenital pathology of the aortic valve in children include balloon catheter dilatation of the aortic valve, surgical valvuloplasty, the Ross procedure and replacement of the aortic valve with a mechanical prosthesis. Many surgeons point out that these techniques in congenital pathology of the aortic valve yield suboptimal results. This is often due to the lack of a clear-cut definition between surgeons as to what operation should be performed in a particular age group. According to the reports of the majority of researchers, biological prostheses undergo early degeneration and structural changes in paediatric cardiac surgery and yield the worst results. Comparing the main techniques, optimal haemodynamics is observed after the Ross procedure. A disadvantage of this operation is the necessity of repeat intervention on the right ventricular outflow tract, which is required in 20 to 40%. Concomitant surgery of the mitral valve and/or aortic arch during the Ross procedure significantly increases the lethality and the risk of postoperative complications. Compared with an adult cohort of patients, children after prosthetic repair of the aortic valve using a mechanical prosthesis are more often found to have postoperative complications and a higher mortality rate. Yet another problem encountered in paediatric valve surgery is the unavailability of commercial prostheses sized ?19 mm. The duration of the intraoperative parameters for reconstructions of the aortic valve, the Ross procedure, and replacement of the aortic valve by the results of many studies averagely amounts to 74±34 min, 100±56 min, and 129±71 min, respectively. Yet another method which can be used for neocuspidization of the aortic valve in reconstructive surgery of the aortic root in paediatric patients is the use of glutaraldehyde-treated autologous pericardium. In our opinion, given the simplicity of the procedure, duration of the intraoperative parameters, and acceptable initial results reported by some researchers, the Ozaki procedure may be performed in children.


Assuntos
Insuficiência da Valva Aórtica , Estenose da Valva Aórtica , Procedimentos Cirúrgicos Cardíacos , Implante de Prótese de Valva Cardíaca , Adulto , Aorta/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Criança , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Transplante Autólogo , Resultado do Tratamento
2.
Kardiologiia ; 61(1): 98-103, 2021 Feb 10.
Artigo em Russo | MEDLINE | ID: mdl-33706692

RESUMO

This thematic review focuses on recently proposed classification of stages in pronounced aortic stenosis based on the prevalence of extravalvular cardiac damage and its modified variant designed for asymptomatic patients. The review presents studies, which analyzed the predictive significance of the proposed classification. The use of this classification allows predicting the course of disease in patients with pronounced aortic stenosis in valve replacement. The classification is based on routinely used structural and functional echocardiographic signs with already proven predictive values with respect of adverse events in patients after aortic valve replacement. The review discusses limitations of the classification for pronounced aortic stenosis stages based on the prevalence of extravalvular cardiac damage.


Assuntos
Estenose da Valva Aórtica , Traumatismos Cardíacos , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Humanos , Prevalência , Índice de Gravidade de Doença
3.
Kardiologiia ; 61(1): 104-108, 2021 Feb 10.
Artigo em Russo | MEDLINE | ID: mdl-33706693

RESUMO

This article presents a clinical case of successful transcatheter aortic valve implantation in an elderly patient with critical aortic stenosis at the stage of systolic dysfunction with development of genuine cardiogenic shock. The role of transcatheter aortic valve implantation in the pathogenetic treatment of acute heart failure due to decompensated aortic stenosis was briefly discussed.


Assuntos
Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Idoso , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Humanos , Choque Cardiogênico/etiologia , Choque Cardiogênico/cirurgia , Resultado do Tratamento
4.
J Vis Exp ; (168)2021 02 13.
Artigo em Inglês | MEDLINE | ID: mdl-33645575

RESUMO

Scientific efforts in the field of computational modeling of cardiovascular diseases have largely focused on heart failure with reduced ejection fraction (HFrEF), broadly overlooking heart failure with preserved ejection fraction (HFpEF), which has more recently become a dominant form of heart failure worldwide. Motivated by the paucity of HFpEF in silico representations, two distinct computational models are presented in this paper to simulate the hemodynamics of HFpEF resulting from left ventricular pressure overload. First, an object-oriented lumped-parameter model was developed using a numerical solver. This model is based on a zero-dimensional (0D) Windkessel-like network, which depends on the geometrical and mechanical properties of the constitutive elements and offers the advantage of low computational costs. Second, a finite element analysis (FEA) software package was utilized for the implementation of a multidimensional simulation. The FEA model combines three-dimensional (3D) multiphysics models of the electro-mechanical cardiac response, structural deformations, and fluid cavity-based hemodynamics and utilizes a simplified lumped-parameter model to define the flow exchange profiles among different fluid cavities. Through each approach, both the acute and chronic hemodynamic changes in the left ventricle and proximal vasculature resulting from pressure overload were successfully simulated. Specifically, pressure overload was modeled by reducing the orifice area of the aortic valve, while chronic remodeling was simulated by reducing the compliance of the left ventricular wall. Consistent with the scientific and clinical literature of HFpEF, results from both models show (i) an acute elevation of transaortic pressure gradient between the left ventricle and the aorta and a reduction in the stroke volume and (ii) a chronic decrease in the end-diastolic left ventricular volume, indicative of diastolic dysfunction. Finally, the FEA model demonstrates that stress in the HFpEF myocardium is remarkably higher than in the healthy heart tissue throughout the cardiac cycle.


Assuntos
Análise de Elementos Finitos , Insuficiência Cardíaca/fisiopatologia , Modelos Cardiovasculares , Volume Sistólico/fisiologia , Estenose da Valva Aórtica/fisiopatologia , Diástole/fisiologia , Coração/fisiopatologia , Humanos
5.
Niger J Clin Pract ; 24(3): 452-455, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33723123

RESUMO

Transcatheter aortic valve implantation (TAVI) is widely used in high-risk patients with severe symptomatic aortic valve stenosis (AS). The use of traditional surgical aortic valve replacement (SAVR) significantly increases the risk of complications in chronic liver failure with the release of many vasoactive and cytotoxic substrates. In patients with ischemic hepatitis or liver dysfunction along with the severe AS, TAVI may be advantageous due to its minimally invasive nature. However, there is limited information about the outcome of TAVI in a patient with both hepatic and multisystem dysfunction. We report this case demonstrating dramatic result of TAVI in a patient in extremely poor clinical condition due to ischemic hepatitis and hyperbilirunemia.


Assuntos
Estenose da Valva Aórtica , Hepatite , Substituição da Valva Aórtica Transcateter , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Hepatite/complicações , Humanos , Fatores de Risco , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
8.
Ther Umsch ; 78(1): 48-52, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33538630

RESUMO

TAVI - New Frontiers Abstract. In this overview, the current major challenges in the field of TAVI are discussed with available supporting data. Valve-in-valve procedures have become routine with reliable evidence to optimise outcomes and minimise the risk of patient prosthesis mismatch. Treating bicuspid aortic valve anatomy remains a challenge with no imminent sign of randomised data to assist treatment decisions; however, it seems clear that improving transcatheter technology and operator experience can lead to excellent results in selected patients. Despite the lingering risk of valve leaflet thrombosis, dual-antiplatelet therapy after TAVI appears to do more harm than good in comparison to single antiplatelet therapy. Whether oral anticoagulation may yet tip the scales toward net clinical benefit remains to be determined. Finally, with TAVI firmly established as the preferred treatment for patients with high and intermediate surgical risk, and as a suitable alternative to surgery in some low risk patients, increasing attention is being turned to the timing of valve intervention. In particular, there is a clear trend away from the traditional symptomatology and strict haemodynamic parameter-driven strategies that have dictated treatment algorithms until now, toward investigating and treating aortic stenosis before the occurrence of deleterious extra-valvular effects.


Assuntos
Estenose da Valva Aórtica , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Humanos , Fatores de Risco , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
9.
Soins Gerontol ; 26(147): 12-15, 2021.
Artigo em Francês | MEDLINE | ID: mdl-33549235

RESUMO

Interventional cardiology is increasingly being offered to frail elderly people thanks to significant technical progress. Transcatheter aortic valve implantation allows the treatment of aortic stenosis by implanting an aortic bioprosthesis through a catheter, without surgery. The left atrial appendage occlusion limits the risk of ischemic stroke in patients with atrial fibrillation who have a contraindication to anticoagulants. These procedures remain invasive and must be proposed after multidisciplinary consultation.


Assuntos
Estenose da Valva Aórtica , Apêndice Atrial , Fibrilação Atrial , Cardiologia , Substituição da Valva Aórtica Transcateter , Idoso , Estenose da Valva Aórtica/cirurgia , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/cirurgia , Fibrilação Atrial/complicações , Fibrilação Atrial/terapia , Humanos , Resultado do Tratamento
10.
Curr Opin Endocrinol Diabetes Obes ; 28(2): 159-173, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33534258

RESUMO

PURPOSE OF REVIEW: Summarize recent recommendations on clinical management of adults and youth with elevated lipoprotein(a) [Lp(a)] who are at-risk of or affected by cardiovascular disease (CVD). RECENT FINDINGS: There is ample evidence to support elevated Lp(a) levels, present in approximately 20% of the general population, as a causal, independent risk factor for CVD and its role as a significant risk enhancer. Several guidelines and position statements have been published to assist in the identification, treatment and follow-up of adults with elevated levels of Lp(a). There is growing interest in Lp(a) screening and strategies to improve health behaviors starting in youth, although published recommendations for this population are limited. In addition to the well established increased risk of myocardial infarction, stroke and valvular aortic stenosis, data from the coronavirus pandemic suggest adults with elevated Lp(a) may have a particularly high-risk of cardiovascular complications. Lp(a)-specific-lowering therapies are currently in development. Despite their inability to lower Lp(a), use of statins have been shown to improve outcomes in primary and secondary prevention. SUMMARY: Considerable differences exist amongst published guidelines for adults on the use of Lp(a) in clinical practice, and recommendations for youth are limited. With increasing knowledge of Lp(a)'s role in CVD, including recent observations of COVID-19-related risk of cardiovascular complications, more harmonized and comprehensive guidelines for Lp(a) in clinical practice are required. This will facilitate clinical decision-making and help define best practices for identification and management of elevated Lp(a) in adults and youth.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Hiperlipoproteinemias/terapia , Lipoproteína(a)/sangue , Guias de Prática Clínica como Assunto , Adolescente , Adulto , Idade de Início , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/terapia , /complicações , /terapia , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/etiologia , Criança , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hiperlipoproteinemias/sangue , Hiperlipoproteinemias/diagnóstico , Hiperlipoproteinemias/epidemiologia , Lipoproteína(a)/fisiologia , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Fatores de Risco , Adulto Jovem
11.
J Vis Exp ; (168)2021 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-33616094

RESUMO

Calcific aortic valve disease (CAVD), an active disease process ranging from mild thickening of the valve to severe calcification, is associated with high mortality, despite new therapeutic options such as transcatheter aortic valve replacement (TAVR). The complete pathways that start with valve calcification and lead to severe aortic stenosis remain only partly understood. By providing a close representation of the aortic valve cells in vivo, the assaying of T lymphocytes from stenotic valve tissue could be an efficient way to clarify their role in the development of calcification. After surgical excision, the fresh aortic valve sample is dissected in small pieces and the T lymphocytes are cultured, cloned then analyzed using fluorescence activated cell sorting (FACS). The staining procedure is simple and the stained tubes can also be fixed using 0.5% of paraformaldehyde and analyzed up to 15 days later. The results generated from the staining panel can be used to track changes in T cell concentrations over time in relation to intervention and could easily be further developed to assess activation states of specific T cell subtypes of interest. In this study, we show the isolation of T cells, performed on fresh calcified aortic valve samples and the steps of analyzing T cell clones using flow cytometry to further understand the role of adaptive immunity in CAVD pathophysiology.


Assuntos
Estenose da Valva Aórtica/patologia , Valva Aórtica/citologia , Valva Aórtica/patologia , Buffy Coat/efeitos da radiação , Calcinose/patologia , Separação Celular/métodos , Células Alimentadoras/citologia , Citometria de Fluxo/métodos , Linfócitos T/citologia , Valva Aórtica/metabolismo , Células Cultivadas , Células Alimentadoras/metabolismo , Humanos , Linfócitos T/metabolismo
13.
Eur J Prev Cardiol ; 28(1): 87-97, 2021 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-33624104

RESUMO

Along with epidemiologic transitions of the global population, the burden of aortic stenosis (AS) is rapidly increasing and transcatheter aortic valve replacement (TAVR) has quickly spread; indeed, it is nowadays also employed in treating patients with AS at intermediate operative risk. Nonetheless, the less invasive interventional strategy still carries relevant issues concerning post-procedural optimal antithrombotic strategy, given the current indications provided by guidelines are not completely supported by evidence-based data. Geriatric patients suffer from high bleeding and thromboembolic risks, whose balance is particularly subtle due to the presence of concomitant conditions, such as atrial fibrillation and chronic kidney disease, that make the post-TAVR antithrombotic management particularly insidious. This scenario is further complicated by the lack of specific evidence regarding the 'real-life' complex conditions typical of the geriatric syndromes, thus, the management of such a heterogeneous population, ranging from healthy ageing to frailty, is far from being defined. The aim of the present review is to summarize the critical points and the most updated evidence regarding the post-TAVR antithrombotic approach in the geriatric population, with a specific focus on the most frequent clinical settings.


Assuntos
Estenose da Valva Aórtica/tratamento farmacológico , Estenose da Valva Aórtica/cirurgia , Fibrinolíticos/uso terapêutico , Substituição da Valva Aórtica Transcateter , Fatores Etários , Idoso , Estenose da Valva Aórtica/complicações , Humanos , Fatores de Risco
14.
Int Heart J ; 62(1): 104-111, 2021 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-33455986

RESUMO

There is scant information about the incidence, risk factors, and outcomes of coronary obstruction (CO) following valve-in-valve transcatheter aortic valve replacement (VIV-TAVR). A meta-analysis of the published studies from January 2000 to April 2020 was conducted, and the endpoint was CO. A total of 2858 patients were enrolled in this study. The mean age was 77.7 ± 9.8, and 39.9% of them were female. The Society of Thoracic Surgeons (STS) score, European System for Cardiac Operative Risk Evaluation (EuroSCORE), and Logistic EuroSCORE were 8.9 ± 7.8, 16.0 ± 10.9, and 26.3 ± 16.3, respectively. The overall incidence of CO was 2.58%. CO incidence between patients with prior stented and stentless valves were significantly different (1.67% versus 7.17%), with an odds ratio (OR) of 0.25 and a 95% confidence interval (CI) of 0.14-0.44 (P < 0.00001). The first-generation valves were significantly associated with higher CO incidence compared with the second-generation valves (7.09% versus 2.03%; OR, 2.44; 95%CI, 1.06-5.62; P = 0.04), while no statistical difference was found between self-expandable valves and balloon-expandable valves (2.45% versus 2.60%; OR, 0.99; 95%CI, 0.55-1.79; P = 0.98). Virtual transcatheter to coronary ostia (VTC) distance (3.3 ± 2.1 mm, n = 29 versus 5.8 ± 2.4 mm, n = 169; mean difference, -2.70; 95%CI, -3.46 to -1.95; P < 0.00001) and the sinus of Valsalva (SOV) diameter (27.5 ± 3.8 mm, n = 23 versus 32.3 ± 4.0 mm, n = 101; mean difference, -3.80; 95%CI, -6.55 to -1.05; P = 0.007) were enormously shorter in patients with CO. The 24-hour, in-hospital, and 30-day mortality of patients with CO were 10.5%, 30.8%, and 37.1%, respectively. In conclusion, device selections, VTC distances, and SOV diameters may be important factors in assessing the CO risk in VIV-TAVR.


Assuntos
Estenose da Valva Aórtica/cirurgia , Oclusão Coronária/epidemiologia , Oclusão Coronária/cirurgia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Bioprótese/efeitos adversos , Ponte de Artéria Coronária/métodos , Ponte de Artéria Coronária/estatística & dados numéricos , Oclusão Coronária/mortalidade , Feminino , Próteses Valvulares Cardíacas/tendências , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Intervenção Coronária Percutânea/métodos , Intervenção Coronária Percutânea/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Desenho de Prótese , Fatores de Risco , Seio Aórtico/diagnóstico por imagem , Stents , Tomografia Computadorizada por Raios X/métodos , Substituição da Valva Aórtica Transcateter/instrumentação
15.
World J Pediatr Congenit Heart Surg ; 12(1): 142-144, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33407029

RESUMO

We report a case of Bentall and redo-Konno operation. A 39-year-old male with surgical history of Konno operation presented with hemolytic anemia and heart failure. Further evaluations revealed aortic paraprosthetic leak with moderate regurgitation, moderate biventricular outflow tract obstruction, and aortic root aneurysm. During the operation, the old Konno septoplasty patch with organized thrombus and the severely calcified right ventricular patch were replaced, and the aortic root was replaced with a larger mechanical valve in a Valsalva graft. Postoperative images showed appropriately reconstructed biventricular outflow tracts. The Bentall operation with redo-Konno was an excellent option in this situation.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Ventrículos do Coração/cirurgia , Adulto , Aneurisma da Aorta Torácica/diagnóstico , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Reoperação , Tomografia Computadorizada por Raios X
19.
Arterioscler Thromb Vasc Biol ; 41(3): 1179-1190, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33441026

RESUMO

OBJECTIVE: The probability of aortic complications in patients with bicuspid aortic valve is higher in association with aortic regurgitation (AR) compared with aortic stenosis (AS) or normally functioning valves. The objective of this study was to determine whether this is related to the specific characteristics of aneurysmatic dilatation that includes AR or whether AR itself has a negative impact on the aortic wall, independent of aneurysmatic dilatation. Approach and Results: Nondilated aortic specimens were harvested intraoperatively from individuals with tricuspid aortic valves and either AS (n=10) or AR (n=16). For controls, nondilated aortas were harvested during autopsies from individuals with tricuspid aortic valves and no evidence of aortic valve disease (n=10). Histological and immunohistochemical analyses revealed that compared with control aortas, overall medial degeneration was more severe in AR-aortas (P=0.005) but not AS-aortas (P=0.23). This pathological remodeling included mucoid extracellular matrix accumulation (P=0.005), elastin loss (P=0.003), elastin fragmentation (P=0.008), and decreased expression of fibrillin (P=0.003) and collagen (P=0.008). Furthermore, eNOS (endothelial nitric oxide synthase) expression was decreased in the intima (P=0.0008) and in vasa vasorum (P=0.004) of AR-aortas but not AS-aortas (all P>0.05). Likewise, subendothelial apoptosis was increased in AR-aortas (P=0.03) but not AS-aortas (P=0.50). CONCLUSIONS: AR has a negative effect on the nondilated ascending aortic wall. Accordingly, our results support the need for more detailed studies of the aortic wall in relation to aortic valve disease and may ultimately lead to more aggressive clinical monitoring and/or surgical criteria for patients with relevant AR. Graphic Abstract: A graphic abstract is available for this article.


Assuntos
Aorta/patologia , Insuficiência da Valva Aórtica/patologia , Remodelação Vascular , Adulto , Idoso , Aorta/metabolismo , Insuficiência da Valva Aórtica/metabolismo , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/metabolismo , Estenose da Valva Aórtica/patologia , Estenose da Valva Aórtica/cirurgia , Apoptose , Estudos de Casos e Controles , Colágeno/metabolismo , Dilatação Patológica/metabolismo , Dilatação Patológica/patologia , Elastina/metabolismo , Células Endoteliais/metabolismo , Células Endoteliais/patologia , Feminino , Fibrilinas/metabolismo , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Óxido Nítrico Sintase Tipo III/metabolismo , Remodelação Vascular/fisiologia , Adulto Jovem
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